Karen R. Gouze, Ph.D.
Children’s Memorial Hospital
Northwestern University Feinberg School of Medicine
February 25, 2011

Definition:
– The individual’s ability to actively control arousal and one’s responses to it
– Self-regulation occurs in the context of goal attainment
– Mental health is the ability to love well, play well, work well, and expect well
– Ability to self-regulate is critical to all areas

Developmental Progression of Self-
Regulatory Processes
Infants have basic self-regulatory mechanisms —perhaps best captured in notions of temperament
Sensory reactivity has long been subsumed under the construct of temperament.
CFA of Rothbart temperament, sensory regulation yielded three distinct factors — negative affectivity, effortful control, sensory regulation (Gouze et al., 2010)

At 6 months- Babies should be able to tolerate and enjoy being moved and touched. They can sustain interest in an object or person for more than a minute.
Can usually self console.
A 9 month old – should be able to play with one toy for two to three minutes, and attend to a speaking person or look at pictures in a book.

At 12 months- an infant should be moving to musical rhythm and sleeping twelve to fourteen hours at night with naps once or twice daily.
At 18 months- A toddler should enjoy messy play and be demonstrating preferences for toys. They should be sleeping ten to twelve hours and napping one time for three hours.

At 24 months- a toddler should be playing by self for a few minutes, as well as freely playing with playdoh, paint or other such substances. They should enjoy rough house play, most playground equipment.
Three year olds- Should show strong independent drives. May not nap anymore.
They should be able to participate in circle time and interactive games.

Behavior Regulation
Emotion Regulation
Attention Regulation
Sensory Regulation

The ability to inhibit inappropriate behavioral responses
The ability to choose appropriate behavioral responses
Inhibiting or choosing behaviors in response to internal emotional states
(Eisenberg, et. al., 2000)
Early social information processing models of externalizing disorders focused on this approach

Definitional disagreements
Garber & Dodge (1991)-
– “Emotion is like pornography: The experts have great difficulty defining it but we all know it when we see it”

Cole et. al. (2004)
– Changes associated with activated emotions
– Valence of emotion is irrelevant
– Can include changes in the emotion itself
(intensity, frequency)
– Also includes changes in other psychological processes-e.g. memory
Emotion as regulating and emotion as regulated

Ability to focus and sustain attention
Ability to shift attention when appropriate

“The ability to regulate and organize reactions to sensations in a graded and adaptive manner” (McIntosh et al., 1999)
Includes sensory modulation primarily but, more broadly speaking, sensory processing disorder includes:
– Sensory modulation
– Sensory discrimination
– Sensory-based motor disorder

Sensory Processing is an important aspect of normal brain function, enabling us to take in and make sense of many different kinds of sensation coming into the brain along different sensory channels at the same time. The ability to make adaptive responses is dependent upon adequate sensory processing. (Hanschu, p.6)

Diane Ackerman
A Natural History of the Senses, 1990

Relationships Between Self-Regulation and Adaptive School Functioning
Behavior Regulation
– The ability to suppress an inappropriate behavioral response.
– The ability to sit still, follow directions, inhibit impulsive responses (including hitting, shouting out answers, etc.).
– The ability to stand in line, walk down the halls quietly, take out the appropriate work, follow teacher directions.

Relationships Between Self-Regulation and Adaptive School Functioning
Emotion Regulation
– The ability to tolerate frustration (e.g. a difficult assignment)
– The ability to delay gratification—to wait for something you want (e.g. wait your turn to speak).
– The ability to modulate your emotional responses to others —manage feelings of anger, sadness, happiness.

Relationships Between Self-Regulation and Adaptive School Functioning
Attention Regulation
– Ability to maintain and focus attention is critical to school success- (e.g. to attend to lessons, complete assignments, etc.)
– Ability to shift attention as needed is critical to school success (e.g. to transition from one subject to another or one task to another)
– Many believe that the ability to regulate attention is also critical to the regulation of emotion (Posner & Rothbart, 2000)

Relationships Between Self-Regulation and Adaptive School Functioning
Sensory Regulation:
– Related to most aspects of adaptive functioning.
– The ability to respond in behaviorally appropriate ways.
– The ability to manage one’s emotional responses.
– The ability to regulate one’s attention.

Sensory Regulation:
– Difficulty managing the noise, smells, movement, textures of everyday life.
– Difficulty standing in line, staying seated, managing lunch room noise and jostling.
– Difficulties in the classroom, the gym, the lunchroom, the hallways

The Relationship Between SPD and
Emotional and Behavior Disorders
Increasing evidence for a relationship between poor sensory processing and:
– ADHD (Dunn & Bennett, 2002; Mangeot et al., 2001; Parush et al., 1997).
– Externalizing disorders (Ben-Sasson et al.
2009; Gouze et al., 2009; Gunn, 2008).
– Internalizing disorders (Goldsmith et al., 2006;
Gouze et al. 2009).
– Later fearfulness (Calkins et al., 1996).

Relationships between Self-Regulation and
Adaptive Functioning
Parents of children with SPD report impaired daily functioning across a range of daily activities
(Dunn, 1997, 2001).
Parents of children with sensory overresponsiveness report more early and concurrent socio-emotional problems and lower levels of adaptive skills than parents without these problems (Ben-Sassoon et al. 2009)

Relationships Between Self-Regulation and
Adaptive School Functioning
Sadhwani and colleagues (2006) found a strong positive relationship between good sensory processing and the development of effortful control.
Effortful control is critical in school to the ability to apply oneself persistently to a difficult task and manage one’s emotions.

Relationships between Self-Regulation and
Adaptive Functioning
Children with SPD show a range of problems with other aspects of self-regulation including attention and emotion regulation, differential physiological reactivity and emotional and behavior problems.

The Relationship Between SPD and
Emotional and Behavior Disorders
PACT (NIMH RO1- MH063665, PI- John
Lavigne, Ph.D. )
Findings:
– 33%- 63% of 4 year old children with SPD
(based on a short sensory profile) have another psychiatric disorder —ODD, ADHD, depression, or anxiety.
– 37%-67% have only SPD

– To examine the constitutional
(temperament, sensory regulation) and psychosocial (attachment, parenting) factors contributing to externalizing and internalizing disorders in 4-year-olds.
– To determine whether psychosocial variables mediate the relationships between constitutional vulnerability and disorder.

N = 796 children and their parents
Age 4-5 years (mean = 4.6)
Gender
– 389 (48.8%)boys
– 401 (50.3%) girls
Ethnicity
– 451 (56.6%) Non-Hispanic White children
– 136 (17.1%), African American children
– 158 (19.8%), Hispanic children

Temperamen t: Child Behavior Questionnaire ( CBQ;
Rothbart, Ahadi, Hershey & Fisher, 2001 )
Sensory Regulation : Short Sensory Profile (McIntosh et. al. 1999)
Attachment : Attachment Q-Sort ( AQS; Vaughn & Waters,
1990)
Parenting
– Parenting Behavior Inventory
(Lovejoy et al., 1999)
– Three Boxes Task
(NICHD Early Child Care Research
Network, 1999 )
Symptoms of disorders : Child Symptom Inventory
( Gadow &Sprafkin, 2002 )

Expert ratings were used to reduce item overlap on temperament, sensory regulation and symptom measures.
Items on each measure were rated on
Likert scales.
Mean ratings were used to eliminate overlapping items from each scale.

13 Pure Sensory Items were retained from the following scales:
– Tactile
– Movement
– Low energy
– Visual-auditory
– Taste

Two scales were eliminated as containing items that were more closely related to temperament or emotional/behavior disorder:
– Seeks sensation
– Auditory sensitivity

Overall model contributed 33% of the variance
– (F= 54.45 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β =-.34)
– Effortful Control (β = -.19)
– PBI Hostile/Coercive Parenting (β =.23)
– AQS (β =-.10)

Mediators of relationship between SR and
ODD
– PBI Hostile/coercive parenting
– Attachment
Mediators of relationship between EC and
ODD
– PBI Hostile/coercive parenting
– Attachment

Overall model contributed 42% of the variance
– (F= 83.15 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β =-.35)
– Effortful Control (-.33)
– PBI Supportive/Engaged Parenting (β = .07)
– Positive Parenting (β = -.07)
– PBI Hostile/Coercive Parenting (β =.16)
– AQS (β =-.12)

Mediators of relationship between SR &
ADHD
– Positive parenting,
– PBI Hostile/Coercive Parenting
– AQS
Mediators of relationship between EC &
ADHD
– Positive parenting,
– PBI Hostile/Coercive Parenting
– AQS

Overall model contributed 38% of the variance
– (F= 68.59 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β = -.46)
– Effortful Control (β = -.19)
– PBI Hostile/Coercive Parenting (β = .13)
– AQS (β = -.09)

Mediators of relationship between SR &
GAD
– PBI Hostile/coercive parenting
– Attachment
Mediators of relationship between EC &
GAD
– PBI Hostile/coercive parenting
– Attachment

Overall model contributed 29% of the variance
– (F= 45.51 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β = -.38)
– PBI Supportive/Engaged Parenting (β = -.08)
– PBI Hostile/Coercive Parenting (β =.14)
– Positive Parenting (β = -.07)
– AQS (β = -.09)

Mediators of relationship between SR & MDD
– PBI Supportive/Engaged Parenting; Positive parenting
– PBI Hostile/Coercive Parenting
– Attachment
Mediators of relationship between EC & MDD
– PBI Supportive/Engaged Parenting; Positive
Parenting
– PBI Hostile/Coercive Parenting
– Attachment

Both constitutional and psychosocial variables are related to concurrent measures of internalizing and externalizing disorders but different patterns emerge.
Sensory regulation was the only variable related to every disorder.
Negative affect was not related to any of the disorders.
Effortful control was related to both externalizing disorders and GAD, but not to MDD

This research was supported by NIMH grant
#RO1MH063665, PI: John Lavigne, Ph.D.
Research assistants
– Kyla Aimone, Hyo Bae, Karyn Brasky, Elisabeth
Carrigg, Helen Chee, Vanessa Christian, Maria
D’Aniello, Carly Demopoulos, Ilana Gonik, Bryce
Hella, Jamie Howard, Jen Keller, Lindsay Pate,
Ginger Robinson, Edna Romero, Joshua Shulruff,
Jen Strickland, Roberto Uribe
Thanks to the parents and children who graciously allowed us into their homes.

The Relationship Between SPD and
Emotional and Behavior Disorders
Are SPD and emotional and behavior disorders separate?
– Yes, remember 37%-67% of SPD children in this sample did not have any emotional or behavior problems BUT:
– SPD is clearly a significant risk factor for the development of emotional and behavior problems AND:
– SPD and emotional and behavior problems often occur co-morbidly.

So, how do we understand and clinically address these relationships?
Sensory regulation is critical for healthy child development —for the development of self-efficacy, feelings of mastery, identity and understanding one’s place in the world.
Self-regulation is critical for adaptive functioning.

Meet Jorge, age 6
Problems at home
– Uncooperative
– Unresponsive
– Hard to move through the day
– Moody and anxious
– Disorganized

Problems at school:
– Incomplete work
– Disorganized
– Difficulty “getting started”
– Uneven academic skills
– Clumsy

Problems with peers:
– Difficulty making friends
– Perceived as aggressive
– Left behind in group settings
– Withdrawn on playground

School Observation

Thinking About Jorge Through a
Sensory Lens
Who He Is
What He Must Do
Where He Is
What
Happens
Success or
Failure

Looking at Jorge
Through the Sensory Lens
Who He Is:
– Auditory defensiveness
– Poor proprioceptive discrimination
– Proprioceptive insensitivity
– Poor tactile discrimination

Attentional Lens
Inattentive ADHD
Learning Lens
Visual-spatial deficits
Slow processing speed

Where He Is:
– Loud classroom
– Restricted desktop space
– Crowded classroom
– Cluttered visual environment

What He is Expected to Do:
– Work independently
– Cut, paste, assemble project parts in sequence
– Look up/down and back/forth from board to desktop to copy model of project
– Stay seated
– Screen out irrelevant noise and movement
– Keep materials organized on desktop

Multiple lenses are required to understand
Jorge:
– Sensory challenges
At home
At school
With peers
– Attentional challenges
– Family issues

Helping the Dysregulated Child
The role of the occupational therapist
– Experts in the treatment of sensory regulation
The role of the educator
– Experts in learning and the technology of instruction
The role of the psychologist
– Experts in the treatment of behavioral and emotional regulation

Three areas of sensory processing disorder:
– Sensory modulation
– Sensory discrimination
– Sensory-based motor planning

Dysfunctional Modulation:
Hypersensitivity
Sensory Experience too loud too rough too bright too spicy too “scratchy” too fast
Observable Behavior hyper-responsive overwhelmed anxious holds back, withdraws resistant overstimulated

Dysfunctional Modulation:
Sensory Insensitivity
Sensory Experience too soft too low too slow too bland too loose
Observable Behavior tuned out sensory-seeking hypo-responsive clumsy messy overactive risk-taking

Remember:
Dysfunctional modulation can be either over- or under-sensitivity.
It can also be a problem of dysregulation, a shifting between the two extremes.
Like poor radio reception, the signal does not come in clearly or consistently.

Some Daily Challenges for the Child with Poor Sensory Modulation
Tolerating noise, making noise.
Personal space.
Seeking stimulation in inappropriate ways or at inappropriate times.
Staying seated, postural control.
Interpreting the emotions and reactions of others accurately.

Dysfunctional Discrimination
Difficulties telling whether sensory input is near/far, hard/soft, coming from the left/right or front/back, threatening/benign, relevant/irrelevant.
These mis-interpretations can interfere with fine-motor skills, early learning, social functioning and appropriate behavior.

Some Daily Challenges for the Child with Poor Sensory Discrimination
Finding things in a cluttered desk.
Tying shoes.
Recognizing ABCs.
Picking out an object in a large array, e.g. on a bulletin board or worksheet.
Handwriting
Interpreting social cues

Dysfunctional Motor Planning
When sensory modulation or discrimination are compromised, a child cannot efficiently conceptualize, plan, or carry out (and remember) motor movements.
Her behavior may appear disorganized, erratic, clumsy, off-task or uncoordinated.

Ideational dyspraxia: difficulty “knowing what to do” or getting started on unfamiliar or complicated motor tasks.This leads to trouble with self-directed and self-initiated activities.

Some Daily Difficulties for the Child With Poor Motor Planning
Learning to talk
Riding a bicycle
Cutting and pasting
Team sports
Getting dressed
Getting started on a school project
Learning a line dance

School is a potential nightmare for the child with sensory processing problems.

A student with inefficient sensory processing is likely to have trouble:
Learning new information
Demonstrating what she knows
Behaving appropriately in the classroom
Moving herself through the daily routines.

The relationship between sensory processing and academic achievement has not been well studied but large numbers of sensory dysregulated children have learning disabilities.
It is reasonable to assume that sensory processing problems will affect learning in both direct and indirect ways.
The more “mismatches” between a child and her school environment, the greater the potential for interference in learning.

This child will need help from teachers and other school personnel in these areas:
Decreasing sensory arousal
Organizing herself/focusing on work
Following directions
Managing her emotions
Getting along with peers

Use the sensory lens to look for
“mismatches” between: the child’s sensory capacities the sensory characteristics of the classroom the sensory demands of the activity she has been assigned.

Remember……….

Looking Through a Sensory Lens
Who He Is
What He Must Do
Where He Is
What
Happens
Success or
Failure

Evan’s story

Distinguishing Sensory, Emotional and
Behavioral Problems
Not always possible.
Think of a key and its many notches.
Try using a good functional behavior analysis.

Use the behavioral lens to look for
“mismatches” between: the child’s behavioral capacities (e.g. selfcontrol, ability to inhibit) the behavioral characteristics of the classroom (e.g. clear vs. unclear rules) the behavioral demands of the activity she has been assigned (requires quiet, sitting still, etc.).

Use the emotional lens to look for “mismatches” between: the child’s emotional capacities (e.g. frustration tolerance, tolerance of disappointment) the emotional characteristics of the classroom
(e.g. affectively charged vs. affectively neutral) the emotional demands of the activity she has been assigned (task that causes strong arousal).

Using the Attentional Lens
Use the attentional lens to look for “mismatches” between: the child’s attentional capacities (e.g.persistent focus, attentional shifting)) the attentional characteristics of the classroom
(e.g. lots of distractions) the attentional demands of the activity she has been assigned (e.g. amount of focused attention required for task completion).

How to analyze a situation to determine sensory, behavioral, emotional contributions to the problem.

Looks beyond the behavior itself.
Identifies child specific cognitive, emotional, social and\or environmental factors associated with the occurrence or non-occurrence of a behavior.

Functional Analysis
Day and time
Problem incident
Behavioral, emotional, sensory characteristics of the environment
Behavioral, emotional, sensory characteristics of the task
Already identified behavioral, emotional, sensory characteristics of the child.

Child’s response
Teacher’s response
Recovery--how long it took and how it was accomplished
Think about using different lenses--who the child is, where he is, what he is being asked to do. What fits best?

Must take into account:

Looking at Jorge
Through the Sensory Lens
Who He Is:
– Auditory defensiveness
– Poor proprioceptive discrimination
– Proprioceptive insensitivity
– Poor tactile discrimination

After sensory issues not too many behavioral issues left —aggression (the major behavioral issue) appears to be related to sensory issues.

Looking at Jorge Through an Emotional
Lens
Gets flooded emotionally when he cannot be successful.
Feels inadequate leading to emotional
“shut-down”

Looking at Jorge Through an
Attentional Lens
Inattentive ADHD —difficulty sustaining focus even in quiet situations.

Where He Is:
– Loud classroom
– Restricted desktop space
– Crowded classroom
– Cluttered visual environment

What He is Expected to Do:
– Work independently with sustained focus.
– Cut, paste, assemble parts in sequence.
– Look up/down and back/forth from board to desktop to copy model of project.
– Stay seated.
– Screen out irrelevant noise and movement.
– Keep materials organized on desktop.

Desk organizer
Come in earlier than the crowd of classmates.
Organize area for entire class for backpacks and coats.
Give Jorge work packet at his desk to minimize looking up and down.
Sensory shelter area for work/noise blocking headphones.

Additional time for writing/ability to take unfinished assignments home without penalty.
Lots of praise for progress.
Medication for inattentive ADD.
Family therapy with behavioral/emotional emphasis to manage tasks of daily living and provide a sense of positive self worth.
Occupational therapy in and out of school for sensory and fine motor issues.

School Based Interventions
Be preventive
Use a collaborative problem solving approach
(see Ross Greene: “The Explosive Child”, “Lost at School”)
Use a functional analysis to determine when and how to intervene.
Think “multi-determined”.

Be preventive —use a sensory diet

The Sensory Diet
A sensory diet is the assortment of sensory experiences a child (or grown up) is exposed to on a regular basis. The type, timing, intensity and duration of these experiences determine their influence on the child’s mind, body, behavior and emotions.

Movement and Balance
– Jumping
– Swinging
– Pushing/Pulling
– Rocking
– Sitting assists

Touch
– Swaddling
– Weighted Blankets/Vests
– Bear Hugs
– Massage
– Textured Play

Volume Control
– Hideaways
– Lighting, Colors, Smells, Sounds
– Relaxation

By raising a child’s awareness of her sensory diet, you are teaching her to tune in to her body and to recognize and respect her sensory needs.

Helping a Child to Help Himself
Talking honestly about sensory sensitivities and behavioral and emotional difficulties helps a child become aware of his own needs.
Problem-solving difficult situations from all perspectives allows him to accept his vulnerabilities and teaches him how to recognize and accommodate them.
Emphasizing his strengths encourages him to persevere.

Challenge
– Lockers/proximity, spacing, fine motor
– Lunch/noise level, crowds, seating, carrying tray
– Music class/noise level, pitch sensitivity
Modification
– Locate locker at end of row, key or additional time
– Lunch alternative, perimeter seating, beginning or end of lunch line
– Sensory shelter or ear plugs

Challenge
– Classroom noise
– Anxiety/stress with changes in routine
– Writing difficulties
Modification
– Place in quiet classroom, earplugs, sensory breaks
– Early warning for changes
– Word processing, dictation, notetaker

Challenge
– Seating/furniture height, traditional posture, movement, space
– Physical education/uniform, changing time, locker, echo
Modification
– Seat at perimeter, cushion, leave room for minor movement, bands on chair legs
– Consult with
PE/PT/modification to classes, alternate uniform (or undergarment), key

Good behavioral control requires:
– Building a positive relationship.
– Lots of praise.
– Clear and reasonable expectations.
– Predictable consequences for misbehavior.

Behavior management programs:
– Select a few target behaviors.
– Make sure the child understands the behavioral goals.
– Select short time periods—the goal is for the child to be successful.
– Be consistent with earned rewards.
– Communicate with home.

Stay away from power assertive approaches.
Plan ahead —avoid situations that create sensory or emotional discomfort.
Discriminate between “must do” and optional tasks.

Effective consequences are:
– Immediate
– Logical
– Fair (smaller works better than larger)
– Universally applied
– Enforceable

Too many target behaviors.
Target behaviors are vague or subject to interpretation.
Too long a time period until feedback.
Poor reward structure.
Rewards are not given or are withheld.
No connection between school and home.
Child does not understand the program.

Jorge:
– Reward task completion.
– Set goal to complete “morning work” in packet.
– Start with completion of smaller amount of work.
– Immediate reinforcement—a sticker on an index card that goes home to mom.
– Possible reward in school—special job/help teacher (requires 80% success in week).
– Gradually increase demands.

Modeling- a calm teacher is the best model.
Emotional reactivity causes adults to be more emotionally reactive.
Down-regulate the emotions in the classroom.
Allow for emotional “chill-outs”

Cognitive-behavioral techniques
– Teach children to recognize physical cues.
– Teach children the language of emotion.
– Teach children relaxation techniques.
– Thought stopping.
– Changing channels.
– Cool tools.

Breathing exercises
Visual imagery —e.g. “turtle”, a “web”, a calming place
Deep muscle relaxation
Sensory shelters
Other sensory input

Teach children the relationship between thoughts, feelings, and actions
Teach them control over their thoughts
Externalizing the problem —”what can you do to keep anger out when he comes knocking on your door?”

Thought switching —shifting from negative to positive thoughts
Use cartoon imagery and thought bubbles —have children practice, practice, practice

Have children make a “tool box” with their favorite techniques
Reward them for using their “cool tools”
Use story telling to reinforce the use of
“cool tools”

Identify children’s strengths.
Provide opportunities for these strengths to flourish and be publicly celebrated.
Allow child to “shine” in these areas.
Find adult supports-critical for these children. (De-escalation requires a trusting relationship).
Children are much less likely to be reactive if they feel appreciated!

For a child with sensory modulation difficulties:
Noise may seem louder
Scrapes may be more painful
Tumbling and jostling may be threatening
High fives may be too hard
May always be “in your face”

For a child with sensory discrimination difficulties:
Difficulty with group projects involving planning and assembly.
Difficulty telling when a peer’s touch is friendly or fearsome.
Difficulty discriminating emotional expressions.

A child with poor motor planning might have difficulty with:
Baseball
Basketball
Hopscotch
Four Square
Other recess activities

For a child with behavioral regulation difficulties:
Waiting his turn might be difficult
Not grabbing things that are appealing is harder
Not saying the first thing that comes to his mind is a challenge

For a child with emotional regulation difficulties:
Tolerating others’ negative emotions.
Delaying gratification.
Tolerating frustration.
Managing uncomfortable feelings.
Modulating anger.

A child with attention regulation issues might have difficulty:
Shifting attention to new games or activities.
Maintaining interest in a given social exchange or activity.
Following quickly paced social interactions .

Children with self regulation difficulties often feel assaulted or out of control. Their response is to be rigid and controlling —a sure fire way to alienate their teachers and their peers.

Difficulty organizing themselves or others.
Difficulty managing more than one child at a time.
Difficulty translating their ideas into action.

Difficulties with Structured Group
Activities
Motor demands may be too difficult.
May take them longer than others to manage the task so they lag behind their peers.
For many sensory kids, “two is company, three is a crowd”.

Alternatives to lunch/recess.
Social skills groups.
Classroom based bullying interventions.
Help the child select activities at which she can be successful.

Children with sensory, behavioral, emotional and social problems often have multiple needs:
They may require extra instructional support.
They may be eligible for special education services.
They may be on medication.
They may benefit from counseling or social work services.

Their team of helpers may include:
– Classroom teachers
– Parents
– Occupational therapist
– LD specialist
– Speech/language therapist
– School psychologist
– Behavior specialist
– Private therapist
– Other people at school important to the child

The purpose of the team is to recommend strategies to help the child succeed.
Focus on child’s strengths as well as her weaknesses.
Improve sensory climate and reduce/alter sensory demands placed on child.
Implement appropriate behavioral and emotional interventions.
Work toward the “just-right challenge.”

There are no magic bullets.
The sensory lens can be a helpful guide.
Sensory sensitive solutions require stepping back, analyzing the situation, generating solutions, and trying them out.
Behavioral, emotional and social interventions are necessary adjuncts to sensory interventions!

Ackerman, D. (1990). A natural history of the senses. New York: Random
House.
Ben-Sasson, A.; Carter, A.S.; & Briggs-Gowan (2009) Sensory overresponsivity in elementary school:Prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37 (5), 705-716.
Calkins, S.D., Fox, N.A. & Marshall, T. (1996). Behavioral and physiological antecedents of inhibited and disinhibited behavior. Child Development , 67 ,
523-540.
Cole, P.M.; Martin, S.E.; & Dennis, T.A. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75, 377-394.
Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Young
Children, 9(4) , 23-35

Dunn, W. (2001). The Sensations of Everyday Life: Empirical, Theoretical and Pragmatic Considerations. The American journal of Occupational
Therapy, 55(6) , 608- 620.
Dunn, W., & Bennett, D. (2002). Patterns of sensory processing in children with attention deficit hyperactivity disorder. Occupational Therapy Journal of
Research , 22 , 4-15.
Eisenberg, N., Guthrie, I. K., Fabes, R. A., Shepard, S. A., Losoya, S. H.,
Murphy, B. C., et al. (2000). Prediction of elementary school children's externalizing problem behaviors from attentional behavioral regulation and negative emotionality. Child Development, 71 (5), 1367-1382
Gadow, K. D., & Sprafkin, J. (2000). Early Childhood Inventory 4 Screening
Manual . Stonybrook, NY: Checkmate Plus.
Garber, J. & Dodge, K.A.(Eds.) (1991). The Development of Emotion
Regulation and Dysregulation.
New York: Cambridge University Press.

Goldsmith, H.H., Van Hulle, C.A., Arneson,C.L., Schreiber, J.E., &
Gernsbacher, M.A. (2006). A population- based twin study of parentally reported tactile and auditory defensiveness in young children. Journal of
Abnormal Child Psychology , 34 (3), 393-407.
Gouze, K.R., Hopkins, J., LeBailly, S.E., & Lavigne, J.V. (2009). Reexamining the epidemiology of sensory regulation dysfunction and comorbid psychopathology. Journal of Abnormal Child Psychology, 37 (8), 1077-
1087.
Gouze, K.R.; Lavigne, J.V., Hopkins, J.; Bryant, F., & LeBailly, S.A. The relationship between temperamental negative affectivity, effortful control and sensory regulation, Unpublished manuscript.
Greene, R. W. (1998). The explosive child: A new approach for understanding and parenting easily frustrated “chronically inflexible” children. New York: Harper Collins.

Greene, R.W. (2008). Lost at school: why our kids with behavioral challenges are falling through the cracks at school and how we can help them. New York: Scribner.
Gunn, T.E. (2008) Relationship between sensory deficits, oppositional defiant disorder, and externalizing behaviors in an urban preschool population. Dissertation Abstracts International: Section B: The Sciences and Engineering , 68 (11-B),
Hopkins, J., Gouze, K.R., Sadhwami, A., Radtke, L. LeBailly, S. A. &
Lavigne, J.V. (2008) Temperament, sensory regulation, parenting, and attachment differentially lead to internalizing and externalizing behaviors in
4-year olds. Paper presented at the 20th Annual Association for
Psychological Science Convention, Chicago, IL.

Lovejoy, C. M., Weis, R., O’Hare, E., & Rubin, E. C. (1999). Development and initial validation of the Parent Behavior Inventory. Psychological
Assessment, 4 , 1-12.
Mangeot, S.D., Miller, S.J., McIntosh, D.N., McGrath-clarke, J., Simon, J.,
Hagerman, R.J., & Goldson, E. (2001). Sensory modulation in children with attention deficit hyperactivity disorder. Developmental Medicine & Child
Neurology , 43 , 399-406.
McIntosh, D.M., Miller, L.J., Shyu, V., & Hagerman, R.J. (1999). Sensorymodulation disruption, electrodermal responses, and functional behaviors.
Developmental Medicine and Child Neurology , 41 , 608-615
NICHD Early Childhood Research Network (1999). Child care and motherchild interaction in the first three years of life. Developmental Psychology,
35 , 1399-1413.

Parush, S., Sohmer, H., Steinberg, A. & Kaitz, M. (1997). Somatosensory functioning in children with attention deficit hyperactivity disorder.
Developmental Medicine & Child Neurology , 39 , 464-468.
Posner, M. I. & Rothbart, M. K. (2000).Developing mechanisms of selfregulation. Development and Psychopathology, 12, 427-441.
Rothbart, M. K., Ahadi, S. A., Hershy, K. L., & Fisher, P. (2001).
Investigations of temperament at three to seven years: The Children's
Behavior Questionnaire. Child Development, 72 (5), 1394-1408.
Sadhwani, A.; Bae, H.; Strickland, J.; Gouze, K.; Hopkins, J.; & Lavigne, L.
(2006) Do parenting behaviors moderate the relationship between negative affect, sensory processing, and effortful control? Poster presentation at the
Biennial Meeting of the Society for Research in Child Development, Boston,
MA.
Vaughn, B. E., & Waters, E. (1990). Attachment behavior at home and in the laboratory: Q-Sort observations and Strange Situation classifications of one-year-olds. Child Development, 61 , 1965-1973.